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Biomedical subjects

S Radley

Publications and source records attributed to S Radley.

At least 19 recordsLinked to original sources
PubMed2006

Methods of repair for obstetric anal sphincter injury.

BACKGROUND: Anal sphincter injury during childbirth - obstetric anal sphincter injuries (OASIS) - is associated with significant maternal morbidity including perineal pain, dyspareunia and anal incontinence. Anal incontinence affects women psychologically and physically. Many do not seek medical attention because of embarrassment. The two recognised methods for the repair of damaged external anal sphincter (EAS): are end-to-end (approximation) repair and overlap repair. OBJECTIVES: To compare the effectiveness of overlap repair versus end-to-end repair following OASIS in reducing subsequent anal incontinence, perineal pain, dyspareunia and improving quality of life. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 January 2006), MEDLINE (January 1966 to 31 January 2006), EMBASE (January 1974 to 31 January 2006), SciSearch (January 1974 to 31 January 2006) and conference proceedings of obstetrics and gynaecology, surgery and coloproctology. SELECTION CRITERIA: Randomised controlled trials comparing different techniques of immediate primary repair of EAS following OASIS. DATA COLLECTION AND ANALYSIS: Trial quality was assessed independently by all authors. MAIN RESULTS: Three eligible trials, of grade A quality, involving 279 women, were included. There was considerable heterogeneity in the outcome measures, time points and reported results. Meta-analyses showed that there was no statistically significant difference in perineal pain (relative risk (RR) 0.08, 95% confidence interval (CI) 0.00 to 1.45, one trial, 52 women), dyspareunia (RR 0.62, 95% CI 0.11 to 3.39, one trial, 52 women), flatus incontinence (RR 0.93, 95% CI 0.26 to 3.31, one trial, 52 women) and faecal incontinence (RR 0.07, 95% CI 0.00 to 1.21, one trial, 52 women) between the two repair techniques at 12 months but showed a statistically significantly lower incidence in faecal urgency (RR 0.12, 95% CI 0.02 to 0.86, one trial, 52 women) and lower anal incontinence score (weighted mean difference -1.70, 95% CI -3.03 to -0.37) in the overlap group. Overlap technique was also associated with a statistically significant lower risk of deterioration of anal incontinence symptoms over 12 months (RR 0.26, 95% CI 0.09 to 0.79, one trial, 41 women). There was no significant difference in quality of life. AUTHORS' CONCLUSIONS: The limited data available show that compared to immediate primary end-to-end repair of OASIS, early primary overlap repair appears to be associated with lower risks for faecal urgency and anal incontinence symptoms. As the experience of the surgeon is not addressed in the three studies reviewed, it woudl be inappropriate to recommend one type of repair in favour of another.

Anal Canal↗
PubMed2006

Prevalence of anal incontinence according to age and gender: a systematic review and meta-regression analysis.

CONTEXT: Anal incontinence is increasingly being recognised as a significant cause of physical and psychological morbidity with implications for healthcare provision within the community. There is controversy about which population groups are most disadvantaged by this chronic condition. OBJECTIVES: The aim of this study was to evaluate the prevalence of this condition in the community according to age and gender, a systematic review was performed. DATA SOURCES: Data were from Embase, Medline, bibliographies of known articles and contact with experts. STUDY SELECTION: Studies were selected if data on anal incontinence could be extracted for participants over 15 years of age and living in the community. DATA EXTRACTION: Data were extracted using a piloted form on participants' characteristics, study quality and incontinence rates. DATA SYNTHESIS: Meta-analysis was used to combine data from multiple studies, and meta-regression evaluated the variation in rates according to age and gender in an analysis adjusted for study quality. RESULTS: There were 29 studies (69,152 participants), of which 5 met over half of the high quality criteria. The rate of solid and liquid faecal incontinence among people aged 15-60 years was 0.8% [95% confidence interval (CI) 0.3-1.9] in men and 1.6% (95% CI 0.8-3.1) in women. In those aged over 60, this increased to 5.1% (95% CI 3.4-7.6) in men and 6.2% (95% CI 4.9-8.0) in women. Meta-regression showed that age had a significant influence on rates of solid and liquid faecal incontinence (p = 0.007), but not gender (p = 0.368) or study quality (p = 0.085). CONCLUSIONS: The rate of solid and liquid faecal incontinence in older people is significantly higher than their younger counterparts. Gender differences in rates did not reach statistical significance.

Adolescent↗
PubMed2006

Development and psychometric testing of a symptom index for pelvic organ prolapse.

A wide range of symptoms are commonly ascribed to pelvic organ prolapse including pain, awareness of lump, bowel, bladder and sexual dysfunction. The aim of this work was to develop and validate an instrument to quantify symptoms related to pelvic organ prolapse. Consultation with symptomatic women and specialists in coloproctology, urology, gynaecology and sexual health resulted in a questionnaire with 25 questions. In total, 203 women participated in a psychometric testing of this instrument, 152 cases with prolapse and 51 controls without. The content validity, criterion validity, reliability and responsiveness of the questionnaire were evaluated. The questionnaire proved a reliable and valid instrument for the assessment of symptoms related to uterovaginal prolapse. It is also sensitive to change.

Case-Control Studies↗
PubMed2005

Importance of evacuatory disturbance in evaluation of faecal incontinence after third degree obstetric tear.

OBJECTIVE: To correlate anorectal function including rectal evacuation with anorectal physiology and endoanal ultrasound in women with third degree obstetric anal sphincter injury repaired at the time of delivery. PATIENTS AND METHODS: Forty-four women with repaired third degree tears underwent anorectal physiology, anal ultrasonography and clinical assessment using the St. Marks incontinence score (0-24). Evacuatory disturbance was assessed by questionnaire. RESULTS: There was a significant correlation between disturbed evacuation and incontinence symptoms (P=0.030). There was also a significant correlation between disturbed evacuation and internal anal sphincter (IAS) injury (P=0.026), but there was no correlation with external anal sphincter (EAS) injury. There was a correlation between disturbed evacuation and low resting anal pressure (P=0.013). Although IAS defects were associated with low anal pressure, only the correlation with Maximum Squeeze Pressure reached statistical significance (P=0.018). CONCLUSION: Women with evacuatory disturbance after repaired third degree tears have a greater level of incontinence than those whose emptying is normal. This association is related to internal sphincter injury and reduced anal sphincter pressures.

Adolescent↗
PubMed2004

The first 18 months of a new perineal trauma clinic.

Anal incontinence after childbirth is both distressing and disabling. A perineal trauma clinic was set up at the Birmingham Women's Hospital with an obstetrician, a urogynaecologist and a colorectal surgeon to improve the follow-up of women with obstetric anal sphincter injury or childbirth-precipitated anal incontinence. Fifty-five women attended the clinic. Forty-one had sustained a recognised obstetric anal sphincter injury at delivery and of these women, 61% were symptomatic with 22% leaking solid or liquid faeces. Fourteen women attended with anal incontinence who had not been recognised as sustaining an anal sphincter injury at the time of delivery. Eleven women were offered a secondary surgical repair of their anal sphincter defect. Seven accepted surgical treatment and 85% (six) were continent following surgery. A perineal trauma clinic offers an opportunity for early assessment and reduction of morbidity from childbirth-related anal incontinence.

Adult↗
PubMed2002

Development and validation of a questionnaire for the assessment of bowel and lower urinary tract symptoms in women.

OBJECTIVE: To develop a simple but sensitive instrument to evaluate and document symptoms of both bowel and urinary dysfunction in women. DESIGN: A 22-item questionnaire covering a range of bowel and urinary symptoms was developed and underwent rigorous psychometric testing. SETTING: The gynaecology departments of three hospitals, a urogynaecology clinic, a functional bowel clinic and a general practice. POPULATION: Six hundred and thirty women, comprising four groups: 1. women awaiting hysterectomy (n = 379), 2. women following hysterectomy (n = 45), 3. women referred with functional bowel and/or urinary symptoms (n = 65), 4. asymptomatic controls (n = 141). MAIN OUTCOME MEASURES: The content, construct and criterion validity, internal consistency, reliability and responsiveness of the questionnaire were measured. RESULTS Peer and patient reports and missing data patterns supported face and content validity. Factor analysis showed a clinically relevant four-factor structure with low content replication able to distinguish between patient groups, indicating good internal structure. Comparison with clinical, anorectal physiological, videoproctographic, transit time and urodynamic test results provide provisional indication of criterion validity. Key domain question analysis and Cronbach's alphas showed internal consistency. Kappa values demonstrated good test-retest reliability and key question correlation over time proved responsiveness. CONCLUSIONS: Our findings support the suitability, clinical validity, reliability and responsiveness of a simple questionnaire, which is sensitive to the constraints of clinical practice. The authors recommend its use in health care evaluation research assessing the effects of pelvic surgery and as a useful tool in comparing treatment efficacy.

Adult↗
PubMed2002

A scoring system for the assessment of bowel and lower urinary tract symptoms in women.

OBJECTIVE: To develop a simple scoring system for a validated 22-item questionnaire used to assess bowel and urinary dysfunction in women. SETTING: A urogynaecology clinic, a functional bowel clinic, a district general hospital and a general practice. POPULATION: One hundred and one women referred with functional bowel and/or urinary symptoms and 131 asymptomatic controls. METHODS: A user manual has been prepared. Individual responses to questions are categorised into normal and abnormal and odds ratio tests applied to reflect their sensitivity. RESULTS: Scoring methods have been detailed, and appropriate and sensitive cutoff points defined. CONCLUSIONS: The use of this validated questionnaire is now aided by a user manual, facilitating health care evaluation research into the effects of pelvic surgery on pelvic floor symptomatology. A simple scoring system is provided, making the questionnaire a valuable and accessible research tool.

Adult↗
PubMed2000

Stapled versus sutured closure of loop ileostomy: a randomized controlled trial.

OBJECTIVE: To compare the outcome after conventional sutured loop ileostomy closure with stapled ileostomy closure. SUMMARY BACKGROUND DATA: A defunctioning loop ileostomy is now widely used in colorectal surgery. Subsequent closure may be associated with early complications, particularly bowel obstruction. The results of a preliminary nonrandomized study suggested that there was no significant difference in the rate of complications between sutured and stapled closure of loop ileostomy. METHODS: One hundred forty-one consecutive patients who underwent loop ileostomy between 1993 and 1998 were randomized before surgery to either sutured or stapled loop ileostomy closure. Seventy-one patients had stapled closure and 70 had sutured closure. RESULTS: Both groups were comparable in terms of age, sex, original operation, duration after original operation, and level of operating surgeon. Postoperative bowel obstruction occurred in 10/70 (14%) patients after sutured closure compared with 2/71 (3%) patients after stapled closure. Subgroup analysis of ileostomy closure in patients having an ileal pouch showed no significant difference in bowel obstruction between stapled and sutured closure (2/30 vs. 7/29). The incidence of other complications, readmissions, and reoperations did not differ between the two groups. The stapled closure was only 4 minutes quicker than sutured closure. The mean total hospital stay tended to be shorter after the stapled closure than the sutured closure, but this did not reach statistical significance. CONCLUSIONS: Bowel obstruction occurred less frequently after stapled closure, but the mean hospital stay and readmission and reoperation rate did not significantly differ between the two groups.

Adult↗
PubMed2000

Audit of topical glyceryl trinitrate for treatment of fissure-in-ano.

PURPOSE: To clarify the clinical role of topical glyceryl trinitrate (GTN) in the management of anal fissures. PATIENTS AND METHODS: Fifty-six consecutive patients with fissure-in-ano attending a colorectal clinic from April 1997 to May 1998 included 16 acute and 40 chronic anal fissures. Patients were instructed to apply 0.2% 0.5 g of GTN to the painful area of the anus. Patients were followed-up in the clinic at 4, 8 and 12 weeks, and by telephone interviews at a median follow up of 10 months. RESULTS: Ten of 16 acute fissures (63%) were healed by 4 weeks and 13 (81%) by 8 weeks. Thirteen of 40 chronic fissures (33%) were healed by 8 weeks and 20 (50%) by 12 weeks. Seventeen patients (30%) underwent lateral sphincterotomy and all healed. There were five recurrences within 3 months of treatment with GTN. Thirty-four (61%) suffered from headaches, eight being severe headaches. None of the patients developed incontinence with GTN or lateral sphincterotomy. CONCLUSIONS: Treatment of fissure-in-ano using GTN ointment was effective in up to 50% of patients with chronic anal fissure, and has the benefit of being repeatable if the fissure recurs. Patients should be aware that treatment is likely to take some months to be effective and is associated with significant side effects in up to 15% of patients.

Acute Disease↗
PubMed2000

Long-term results of cutting seton fistulotomy.

BACKGROUND/AIMS: To determine the long term outcome of cutting seton fistulotomy. MATERIALS AND METHOD: An audit of fistula surgery using a cutting seton for cryptoglandular sepsis identified 32 patients treated between 1988-1996. The majority of the patients had a trans-sphincteric (26/32, 81%) fistula. RESULTS: Fourteen (44%) had had previous fistula surgery before seton fistulotomy. Follow up was complete in 28 patients: 8 patients had recurrence (29%), 4 at a new site and 4 at the same site after apparent healing. Major incontinence was reported by 3 patients, minor incontinence by 7 and soiling by 5, but only 7 patients worsened after the cutting seton fistulotomy. Major incontinence was reported only by women who had a previous vaginal delivery. CONCLUSIONS: Cutting setons do not always preserve continence in high trans-sphincteric and complex fistulas. Patients should be warned about a high recurrence rate after cutting seton fistulotomy. The use of a cutting seton for anterior fistulas in female patients with a history of vaginal delivery should be avoided because of the risk of incontinence.

Adult↗
PubMed1995

Activities of phospholipase A2 and diacylglycerol lipase are increased in human colorectal cancer.

Experimental, clinical and epidemiological studies have implicated arachidonic acid and its metabolites as important mediators in colorectal carcinogenesis. Although arachidonic acid levels are increased in tumour membrane lipids, its availability for metabolic processes is not known. The activities of phospholipase A2 (PLA2) and diacylglycerol lipase therefore were assessed in tumour and normal mucosal specimens from 20 patients with colorectal cancer using 14C-radiolabelled substrates. The median (interquartile range) PLA2 activity was increased in tumour tissue (10.5 (6.0, 18.5) pmol arachidonic acid mg-1 h-1) compared with that in normal mucosa (5.6 (2.5, 8.5) pmol arachidonic acid mg-1 h-1) (P < 0.001, Wilcoxon signed rank test). Activity of diacylglycerol lipase was also greater in tumoral tissue (47.4 (21.6, 82.1) pmol arachidonic acid mg-1 h-1) than in mucosa (19.1 (9.4, 42.9) pmol arachidonic acid mg-1 h-1) (P < 0.005). There was no correlation between either PLA2 or diacylglycerol lipase activity and myeloperoxidase activity, suggesting that these increases were not directly attributable to tumour inflammatory cell infiltrate. Augmentation of arachidonic acid release in colorectal tumours may have implications for therapy.

Aged↗
PubMed1994

Biliary bile acid profiles in patients with familial adenomatous polyposis before and after colectomy.

The development of colorectal polyps and cancer in patients with familial adenomatous polyposis (FAP) is directly linked to inactivation of the APC gene. Other, epigenetic, mechanisms may be involved in tumorigenesis and a previous study suggested that an intrinsic difference in the biliary bile acid profile of untreated patients with FAP persisted after colectomy. Gas chromatography and gas chromatography-mass spectrometry were used to examine the biliary bile acid profiles of four groups of patients with normal gallbladders: 20 patients with an intact colon comprising 12 with FAP and eight controls; and 26 patients after colectomy comprising 12 with FAP and 14 controls. Comparison of ten different bile acids from both amidate fractions (glycine and taurine) revealed a small increase in the molar percentage of a minor bile acid (12-oxolithocholic acid) in patients with FAP and an intact colon compared with the matching control group. Colectomy was associated with a dramatic reduction in levels of secondary bile acids but with little difference between patients with FAP and controls.

Adenomatous Polyposis Coli↗